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Pino, Marco (2014) Epistemic struggles in addiction therapeutic community meetings. In: Communicating certainty and uncertainty in medical, supportive and scientific contexts. Dialogue studies (25). John Benjamins, Amsterdam, pp. 201-221. ISBN 9789027210425
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Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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Epistemic Struggles in Addiction Therapeutic Community Meetings1
Marco Pino2
Abstract In this study I analyse Therapeutic Community (TC) group meetings for
persons with drug addiction problems. Using the method of Conversation
Analysis, I specifically focus on practices of knowledge management and
sharing between the educators and clients of a TC in Italy. As part of their
institutional remit, the educators encourage the clients to report information
on their activities and to disclose aspects of their inner experience. This can
lead to epistemic struggles, in which the clients resist providing information
and the educators seek to overcome such resistance by making claims of
pre-existing knowledge about the clients’ experience. After describing the
design and sequential positioning of such claims, I argue that their use is
functional to manage one of the dilemmas that characterise the educators’
professional practice.
Keywords Conversation analysis, Epistemics, Knowledge management, Substance
abuse treatment centers, Therapeutic community
1 Preprint copy of: Pino, M. (2014) Epistemic Struggles in Addiction Therapeutic
Community Meetings. In A. Zuczkowski, R. Bongelli, I. Riccioni and C. Canestrari (Eds.),
Communicating certainty and uncertainty in medical, supportive and scientific contexts, pp.
201-221. John Benjamins. 2 Correspondence to: Corresponding author: Marco Pino - Sue Ryder Centre for the Study
of Supportive, Palliative and End of Life Care - The University of Nottingham, School of
Health Sciences, Queen’s Medical Centre, Nottingham, NG 7 2HA, UK - Email:
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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Therapeutic Communities (TCs) are settings for the rehabilitation and
support of people with mental health and addiction problems. Some of their
distinctive features are: (a) a location removed from a hospital, into a
‘normal’ house; (b) intensive staff input with individual treatment
programmes; (c) expectation of client involvement in domestic activities;
(d) access to opportunities of social involvement in the area where the house
is located (Macpherson, Edwards, Chilvers, David, and Elliott 2009).
Another distinctive mark of TCs is the value attached to group meetings,
which are carried out on a weekly basis with several purposes. The Service
Standards for Addiction Therapeutic Communities mandate that
“discussions take place from which community members learn and gain
understanding from everyday living” (Shah, and Paget 2006, 16). In this
article I analyse such discussions in the context of some group meetings that
I recorded in a larger project in a semi-residential TC in Italy. My aim is to
describe practices of knowledge sharing and management in the TC
meetings. After establishing the central role of knowledge management in
the interactional tensions that arise in the meetings (what I refer to as
epistemic struggles), I focus on a set of practices by which the TC
professionals (called educators) pursue information about the clients’
activities and experiences. Specifically, I focus on how these practices index
different degrees of pre-existing access to the clients’ experiences. Finally, I
discuss their implications for the interaction and the institutional setting of
the TC.
Therapeutic Community Monday Meetings
The TC where I carried out my research provides rehabilitation and
support for people with drug addiction problems. It is located in a major
Italian city, and is managed by a private organization in collaboration with
the local public health service. Clients do not pay to receive treatment. The
TC is not residential: clients attend the TC from Monday to Friday, from
8.00 a.m. to 5.00 p.m.
The meetings analysed in this study are carried out at the TC every
Monday. The meetings are attended by two TC professionals (called
educators) and the TC client members. In the Monday meetings the clients
are expected to report their activities in the course of the weekend (spent
outside the TC). The reporting activity is actively sustained by TC
educators’ interventions that have two main functions: (a) to provide for an
articulated report of the weekend; (b) to isolate in the report one or more
issues or problems that can be subsequently scrutinized and assessed.
In the following example, a client called Carlo starts his report with a
reference to an individual program that the clients write up every Friday, in
which they commit to engage in specific activities in the course of the
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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incipient weekend. Among the functions of the Monday meetings is to
verify whether the clients have followed their individual program. Carlo
starts his report by claiming that he has not abided by the program. Marta
and Annamaria are two TC educators. Other clients are present at the
meeting but they do not intervene in this extract (information on the data
and method for this study are provided in the next section).
Extract 1 (INT4:15)
01 Car Avevo messo che ero (.) I had put that I would be (.)
02 per- per lo più a ca:sa (.) mos- mostly at ho:me (.)
03 a non fare [niente,= and do [nothing,=
04 Mar?? [e:h. 05 Car =e invece:::: son andato un po’ =and instead:::: I went a little
06 di qua e di là. here and there.
07 (1.8) 08 Ann -> Cos’è che hai fatto? What did you do?
09 (0.4) 10 Car Beh son andato:::::::::::: (0.6) Well I went:::::::::::: (0.6)
11 no in città no. no not into town.
12 (0.6) 13 Però son andato a fare un but I went for a
14 giro:::::::::: per centri tour:::::::::: at the shopping
15 commerciali. centres.
16 (0.4) 17 .hhhh sono andato a ((luogo)), (1.8) son .hhhh I went to ((place)), (1.8) I
18 andato:::::::::::::: a ((luogo)) (.) went:::::::::::::: to ((place)) (.)
19 qua in ((luogo)), (0.8) ho fatto un here in ((place)), (0.8) I did some
20 po’ di giretti così, (0.8) spins so, (0.8)
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21 Mar N[o ma- N[o but-
22 Car [per non stare a [casa [not to stay [home
23 Mar -> [Con chi sei andato? [Who did you go with?
24 (0.6) 25 Car (.h) Con i miei. (.h) With my folks.
26 (0.3) 27 Mar A[:h! ((annuisce)) O[:h! ((nods))
28 Car [Con mio padre. [With my father.
In lines 1-3, Carlo produces the first turn constructional unit of an
announcement, stating that he had written in his program that he would stay
at home in the weekend. A speaker (possibly Marta) overlaps the last word
of the unit with a continuer (line 4). Carlo completes the announcement in
lines 5-6 with a second unit. A gap ensues in which Carlo might be expected
to detail his announcement by giving a full report. As he does not do so,
Annamaria issues an inquiry (line 8). In lines 10-20 Carlo reports that he
went to visit some shopping centres, an activity that he eventually glosses as
‘doing some spins’ (lines 19-20). In light of the fact that the exchange takes
place in a TC meeting, in which the client’s report is likely to be inspected
in order to understand whether he engaged in possibly dangerous or anti-
therapeutic behaviours (such as going to places where he might meet people
who could sell him drugs), Carlo’s detailing of what he did makes available
the picture of a rather innocent and harmless type of activity (Drew 1998),
thus downgrading the possible seriousness of his transgression.
This information is treated as insufficient by Marta (another
educator) who produces a second inquiry (line 23) focusing not on where
Carlo went but with whom. Carlo’s response again provides information
that is compatible with the picture of rather innocent and non-harmful
activities: he went out with his parents (information which is revised in line
28, where Carlo mentions his father). Marta’s “ah” token in line 27 indexes
that she has registered the provision of the required information (Heritage
1984), which she reflexively treats as sufficient and adequate for all
practical purposes. In the continuation of the exchange (not shown here),
after Annamaria issues a further inquiry which momentarily shifts the focus
of the discussion, Marta refers back to the information provided in lines 25
and 28 in order to provide a positive evaluation of Carlo’s conduct.
The educators’ inquiries provide for the clients to give information
that can help them to evaluate their conduct in the weekend. Two related
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aspects of the educators’ inquiries are involved in preparing the ground for
an evaluation. First, through their inquiries the educators display an
unknowing epistemic position (Heritage 2012) and thus provide for the
clients to fill their gap of knowledge regarding their activities in the
weekend. Second, the inquiries are selective with respect to the type of
information that can be treated as a relevant requirement to issue an
evaluation. For instance, Marta’s inquiry in line 23 shifts the focus away
from the issue of ‘where’ Carlo went to the issue of ‘with whom’ he went
out.
Another implication stems from the fact that information is not
neutral. For instance, “pubs” and “shopping centres” as possible responses
to the inquiry in line 8 are likely to bear different consequences for the
evaluation of Carlo’s conduct. The same can be said for “friends” and
“parents” as possible responses to the inquiry in line 23. What the client
reports has consequences for how his conduct will be evaluated. Thus, there
are stakes involved in the management of information for both the TC
educators and client members. The educators depend on the clients to
provide reports that are sufficiently detailed and relevant in order to appraise
their conduct. The clients are likely to be alert to the fact that what they say
can be used to evaluate them (this orientation is embodied in Carlo’s initial
announcement in extract 1, where he immediately characterises his conduct
as contradicting his earlier commitments).
Whereas the client in extract 1 cooperates by providing the required
information, interactional tensions commonly arise between the educators
and the client members in this phase. In this article I focus on one source of
such tensions: the displayed unwillingness to provide the information
required by the educators. In such cases, information management can
become an object of struggle. In the following sections I analyse an instance
of this type of epistemic struggle. After showing how a client manages to
withhold information, I analyse three practices that the educators employ to
circumvent his resistance. I intend my article to contribute to two fields.
First, I contribute to the study of TC meetings by arguing that some of the
tensions that arise in them can be usefully conceptualised as epistemic
struggles. Second, I contribute to the study of epistemics in social
interaction (Heritage 2012) by analysing how epistemic rights and
obligations can be managed in a specific type of institutional activity.
Data
Data for this article come from 8 meetings (4 audio-recorded; 4
video-recorded) that I collected in the context of an ethnographic study
carried out in the addiction TC. The participants granted permission to
publish the data. I transcribed the recordings by employing the technique
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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commonly used in Conversation Analysis (CA), and originally devised by
Gail Jefferson, which allows to capture several aspects of speech
production, such as temporality (overlapping speech and silences),
intonation, emphasis and others (for an overview, see Schegloff 2007). The
transcripts in this article are presented in two lines: original Italian, and
English idiomatic translation.
Method
The method for this study is Conversation Analysis (CA). CA is an
approach for the study of how people accomplish social activities through
talk (for an overview, see Sidnell 2010). In this article, I specifically build
on CA studies of epistemics, conceived as “the study of the expression of
and roles played by knowledge and knowledge claims in interaction” (Drew
2012). Heritage (2012) demonstrates that the distribution of knowledge
between participants is a central resource in the organisation of conduct in
social interaction. Specifically, he shows that the relative distribution of
knowledge between participants can be used as a warrant for the initiation
and closure of sequences of action whose main interactional purpose is the
exchange of information. For instance, the display of an unknowing
epistemic position by one of the parties can work as a warrant for the
initiation of a sequence, which is brought to closure when the epistemic
imbalance between the parties has been equalised for all practical purposes.
My study also builds on CA literature on preference organisation,
conceived as the organisation of practices that promote social affiliation in
interaction. When alternative actions are available to a participant – one that
promotes affiliation and one that promotes disaffiliation – the alternative
that promotes disaffiliation tends to be withheld with respect to points in
interaction where it might otherwise be relevantly performed, and it is also
marked by specific compositional features (such as the embedding of
accounts, mitigations, excuses, and others). In this article I draw specifically
on studies of the preference organisation of sequence initiating actions
(Robinson, and Bolden 2010; Schegloff 2007).
In my analyses I focus on phases in the Monday meetings in which
the educators provide for the clients to report their weekend activities. In
this sequential environment, the educators mobilise the clients’ reports by
undertaking an unknowing epistemic position (Heritage 2012). Such
displays vary in the extent to which they exhibit the educators’ lack of
knowledge or, alternatively, some pre-existing knowledge regarding the
matters at hand (whose degree of certainty can be downgraded or upgraded).
I am specifically concerned with how different displays of knowledge
reflect different concerns and bear different interactional implications for
the activity.
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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Pursuing information on a client’s experience
In what follows I analyse an episode taken from a single, audio-
recorded meeting held at the TC. I have selected this particular episode
because it permits illustration of a range of practices involved in dealing
with a client’s reluctance to provide information on his weekend. As I will
make clear in a moment, the task of obtaining information is further
complicated by the educators’ focus on the client’s inner, emotional
experience (i.e. how he felt in the course of the weekend) and not on more
publicly available events (i.e. what he did). The client’s name is Samuele.
Two educators (Annamaria and Marzio) and two other clients (Lidia and
Diana) take part in the meeting. The clients are between 19 and 22 years old.
All names used in this article are pseudonyms. In order to have a sense of
the general focus of discussion, let us consider the following extract.
Extract 2 (Pg3B:1)
01 Sam Venerdì pomeriggio è Friday afternoon he
02 andato via. went away,
03 (1.6)
04 (É) tornato a casa e (He) came back home and
05 ha aiutato a: (.) metter he helped to: (.)set
06 su tipo la *tavola:* (0.2) kind of the *table:* (0.2)
07 (va beh è >robe sue<), (0.2) (okay this is >his stuff<), (0.2)
08 .hh (1.2) però (si è abbassa:to). .hh (1.2) but (he lowered himse:lf).
09 (1.5)
10 .hh (0.7) pranzato, (0.9) .hh (0.7) had lunch, (0.9)
11 ↑ve le sto dicendo così ↑I am telling you things this way
12 le robe perché non because I don’t
13 mi ricordo niente? remember anything?
14 Ann M(h).
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15 [M(h)a per- Ti ricordi perché eri]= [B(h)ut wh- Do you remember why you were]=
16 Sam [( andare un po’ a rilento)] [( go a little slowly)]
17 Ann =scogliona:to?=Per esempio? =annoyed?=For example?
Across lines 1-8 Samuele references events involving his father.
Three aspects are worth noting. First, Samuele provides a factual description
of events that occurred in the previous days (his father went away, then he
came back). Second, Samuele’s talk is not self-oriented, but references a
third person (his father). Third, the idiomatic “he lowered himself” seems to
convey a possible complaint (Drew, and Holt 1988), which is made
available for the recipients to take up (Mandelbaum 1991/1992). Following
a lack of uptake (line 9), Samuele resumes his factual report (line 10) and
then he interrupts it to produce a meta-comment (lines 11-13). In accordance
with what Sacks (1987) described as a preference for contiguity, Annamaria
(an educator) first addresses Samuele’s meta-comment with a laughter token
(line 14). Annamaria then produces an inquiry (lines 15, 17), which shares
the two properties exhibited by the educators’ inquiries in extract 1. First, by
producing a first pair part action that indexes an unknowing epistemic
position, Annamaria makes relevant for Samuele to produce a second pair
part that provides information to close the knowledge gap between them.
Second, the inquiry is selective with respect to the type of information that
the educator treats as relevant in the present context. By referring to an
earlier comment by Samuele on his being “annoyed” on Saturday morning
(not shown here), Annamaria focuses on his inner emotional experience.
This focus stands in contrast with the quality of Samuele’s description
which focused on the facts, instead of his own inner experience, and was not
self-oriented.
Annamaria’s focus on Samuele’s inner experience adds a layer of
complexity to the interaction, compared to the exchange in extract 1. As a
matter of fact, whereas information about external events can be shared by
participants to an interaction, information about one’s own internal
experience is ordinarily treated as something that is owned by the person
(Heritage 2011; Peräkylä, and Silverman 1991). Venturing in the domain of
the other’s experience is, hence, a delicate enterprise and requires the
collaboration of the person who owns the experience. Whereas the client in
extract 1 can be normatively expected to provide information on his
activities in the world (i.e. what he did) insofar as they are treated as
relevant for the business at hand (e.g., assessing whether the client abided
by the TC rules in the course of the weekend), providing for a client to
disclose his internal experience (i.e. what one felt) is a different matter.
Annamaria’s inquiry produces a turning point in the meeting; from
this moment, the progressivity of the activity is made contingent on
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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Samuele’s willingness to describe not the sheer facts in which he was
involved, but what he experienced.
Client’s withholding of information
Samuele employs several practices to withhold information about his
inner experience in the course of the weekend. In this section I consider
three of them.
Withholding talk
Extract 3 (Pg3B:16)
01 Lid Ma [posso chiederti una [cosa? But [can I ask you some[thing?
02 Ann [quando ti sei sve[gliato? [when you woke [up?
03 ?? [°Sì° [°Yes°
04 (0.2)
05 Sam Eh.
06 (1.4)
07 Lid Ma come stavi? But how did you feel?
08 -> (0.9)
09 ?? ↑Mh
10 -> (1.4)
11 Mar Ha detto che era He said that he was
12 scogli↑onato, anno↑yed,
13 (0.4)
14 Sam >Sco↑glionato.< >Ann↑oyed.<
Extract 3 is a direct continuation of extract 2. Following
Annamaria’s inquiry, Lidia (one of the clients) produces a pre-question
(Schegloff 2007) (line 1). Given that this is a first pair part and that it is
produced after another first pair part has already been issued by Annamaria
(who extends it in overlap in line 2), Lidia’s turn competes with
Annamaria’s to become sequentially implicative and, hence, to constrain
Samuele’s response (Schegloff 2000). Samuele’s response in line 5 is
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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clearly addressed to Lidia’s pre-question, in relation to which it constitutes a
go-ahead response (Schegloff 2007). Following this, Lidia produces an
inquiry which has a larger focus than Annamaria’s earlier inquiry, insofar as
it provides for Samuele to tell how he felt in general and not to account for a
specific affective state (such as being annoyed). Nevertheless, this inquiry
shares with Annamaria’s inquiry the focus on Samuele’s inner experience.
Across lines 8 and 10 Samuele withholds talk that could answer Lidia’s
inquiry (the “mh” token in line 9 does not belong to him insofar as it is
uttered by a non-identified female voice). Following Samuele’s lack of
uptake, Marzio (an educator) answers Lidia’s inquiry on Samuele’s behalf
by citing the client’s earlier reference to ‘being annoyed’. Marzio’s answer
also constitutes a B-event statement or “my side” telling, that is, a claim
made into Samuele’s experiential domain (Pomerantz 1980). This type of
statement has been described in earlier studies as making relevant a
responsive action that makes available information from the epistemic
domain in which the claim is being made (Heritage 2012b). In the case at
hand, the sense of a claim which is being produced as a solicitation to talk is
further conveyed by the slightly rising intonation at the end of Marzio’s turn
(line 12). Samuele eventually responds to the solicitation by repeating, and
hence confirming, Marzio’s formulation of his affective state (“annoyed”;
Heritage and Raymond, 2012).
Minimal responses
Extract 3 provides an example of this practice. In line 14, Samuele
confirms Marzio’s formulation of his affective state through the repetitional
“>Sco↑glionato.<”. This answer is minimal in two respects. First, it is
minimal in a material way: it consists of single lexical item, whose
extension is further reduced by the accelerated pace with which it is uttered
(as if Samuele had designed it to occupy as little turn space as possible).
Second, it is minimal in an informational way, insofar as it avoids providing
anything more than what has already been provided by Marzio (Schegloff
2007). Let us turn to another example.
Extract 4 (Pg3B:95)
01 Ann [E tornando alla domanda [And going back to the question
02 che ti ha fatto Lidia. that Lidia asked you.
03 (0.3)
04 Come stavi? How did you feel?
05 (1.3)
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06 Oltre che- (.) cioè Besides- (.) I mean
07 scogliona:to? (ah.)
anno:yed? (ah.)
08 (3.2)
09 Sam Così. So.
10 (0.7)
11 Ann Annoia::to? Triste, Bo::red? Sad,
12 pensieri stra:ni,
stra:nge thoughts,
13 (2.0)
14 Sam ↑No. ↑No.
15 (0.5)
16 tch Pensieri di quel tch Thoughts of that
17 genere no. kind no.
18 (1.6)
Annamaria’s inquiry in lines 1-2 follows another segment of
Samuele’s factual description of his activities in the weekend, with respect
to which it constitutes a topic shift and a further attempt to refocus the talk
on the client’s internal experience. The inquiry references (and renews the
sequential implicativeness of) Lidia’s earlier inquiry shown in extract 3, line
7. In lines 6-7 Annamaria establishes Samuele’s earlier minimal response
(extract 3, line 14) as insufficient. Following a gap, Samuele provides
another minimal response. As in the earlier example, it is minimal both in
the sense of being made of a single turn unit (specifically, a single lexical
item) and of being non-informative. Following Annamaria’s pursuit of a
more informative response (in the form of an alternative question), and after
a further gap, Samuele produces another minimal response, by denying that
the latter of the options provided by Annamaria (the idiomatic “strange
thoughts”, which might refer to thinking about using drugs) applies to him.
After a gap, he expands his turn by adding another turn unit. However, the
response is still minimal insofar as it avoids providing more information on
Samuele’s inner experience.
Factual descriptions
Extract 5 (Pg3B: 353)
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01 Sam Poi sabato pomeriggio è Then Saturday afternoon
02 venuta anche mia sorella a casa also my sister came to my
03 mia. house.
04 (2.3)
05 Abbiam ciaccolato un po’: We chatted a little:
06 io mia sorella e mia ma:mma I my sister and my mu:m.
07 (5.5)
08 Ed è lì che m’ha propo:sto And it was there that she propo:sed me
09 anche di andare °( )° also di go °( )°
10 (3.0)
11 °(Questo.)° °(This.)°
12 (2.5)
13 Mar Ma ieri è stata la giornata But yesterday it was the hardest
14 più dura dicevi comunque. day you said anyway.
Recurrently across the meeting Samuele manages his own
participation by returning to a factual description of the weekend events. In
extract 5, Samuele’s factual description of the events involving his mother
and sister is followed by a “my side” telling by Marzio, who seeks to
refocus the discussion on the client’s internal experience.
Summary
Samuele employs different practices to resist his co-participants’
solicitations to communicate aspects of his inner experience. The practices
that I have illustrated all have implications for the epistemic work carried
out in the meeting. By withholding talk, Samuele avoids providing
information that can close the gap of knowledge indexed in his co-
participants inquiries. Minimal responses enable Samuele to satisfy the
expectation of producing an at least pro forma responsive action to his co-
participants solicitations to talk, while at the same time conveying his
unwillingness to provide more articulated and informative descriptions of
his own experience. Factual descriptions also enable him to meet another
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expectation of the activity in progress – reporting on one’s own activities in
the course of the weekend – while avoiding providing information on one’s
own internal experience.
Samuele’s resistance can jeopardize the activity in progress, insofar
as the selective focus of the educators’ solicitations on Samuele’s inner
experience have made its progressivity contingent on the provision of this
type of information. It should be kept in mind that, in the overall
organization of the meeting, clients’ reports are followed by some type of
responsive action (such as an assessment) in which the educators deliver
their view of the facts that have been reported. In the case at hand, this stage
in the interaction cannot be reached unless Samuele provides the required
information, or unless the educators give up further attempts at pursuing that
information.
Educators’ pursuit of information
The TC educators employ different practices to deal with Samuele’s
resistance and to pursue information about his inner experience. These
practices all mobilize informative sequences and they do so by virtue of
indexing the educators’ lack of knowledge of (and interest in) Samuele’s
state. Nevertheless, these practices are differently positioned on what
Heritage describes as the epistemic gradient (Heritage, and Raymond 2012),
insofar as they encode “different degrees of information gap and different
levels of commitment to the candidate answer advanced by the questioner”
(p. 180). In extract 1 (lines 8 and 23) the educators’ inquiries index a
complete lack of knowledge regarding the client’s activities in the weekend.
In the exchange with Samuele, the educators promote informative sequences
by claiming varying degrees of pre-existing knowledge regarding his
internal states. Different types of claims appear to be treated as non-
equivalent. The educators first employ solicitations that index only generic
or hypothetical knowledge about Samuele’s state. However, following the
client’s non-cooperation, they produce solicitations that encode some pre-
existing knowledge of his internal experience in the weekend. In Heritage’s
terms, the educators gradually alter their epistemic stance and modify the
slope of the epistemic gradient between themselves and the client from deep
to shallow (Heritage 2012). The fact that such knowledge displays are
deployed later in the meeting testifies to their dispreferred or socially
devalued character (Schegloff 2007). It is arguable that the educators
withhold displaying pre-existing knowledge of Samuele’s state in order to
provide for the preferred alternative of having the client communicate
information on his inner state (Robinson and Bolden, 2010). The
dispreferred nature of making claims about the client’s experience is also
reflected in the design of those claims. In what follows I consider three
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
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practices by which the educators pursue information on Samuele’s inner
experience in the weekend, which can be located on a continuum between
the lower to the higher display of knowledge regarding his experience.
Pursuing information from a relatively unknowing epistemic position
Information about Samuele’s inner experience is pursued across his
displays of resistance in several ways, such as different question formats
and candidate answers. Let us consider the alternative question in extract 4,
lines 11-12. It addresses Samuele’s displayed unwillingness to talk about his
inner state by providing a set of alternatives among which he could choose
(Koshik 2010). The question carries an implied claim of knowledge about
Samuele’s experience in general or hypothetical terms. Annamaria builds on
prior knowledge about Samuele’s experience in order to produce a list of
possible answers in a recipient-designed way. Such knowledge grounds, for
example, the possibility that Samuele might have had “strange thoughts”.
Nevertheless, no claim is made or conveyed about how precisely Samuele
felt in the course of the weekend. The alternatives are simply offered as
relevant possibilities, not as actual affective states that Samuele might have
experienced. The question, hence, builds on general knowledge about
Samuele, which is arguably available to anyone who has an established
relationship with him in the TC (educators and clients). In this respect, it
indexes a relatively unknowing epistemic position with regard to the matter
under discussion.
Another instance is in extract 5, lines 13-14. This “my side” telling is
deployed to promote a topic shift and a return to talk that references
Samuele’s inner experience, which it describes through the candidate
formulation “hard”. Through the evidential “you said”, the claim is
cautiously presented as grounded in what Samuele has made available
earlier in the meeting. As in the case of the alternative question in extract 3,
Marzio’s statement displays a comparatively low degree of knowledge
about Samuele’s experience, insofar as its conveyed epistemic claim is
limited to the surface of what Samuele has verbally made available in the
meeting.
What these practices convey is the educators’ interest in gaining
more knowledge of Samuele’s experience. They do so by either pursuing
the disclosure of his experience after his displays of resistance (extract 4) or
by refocusing the talk after Samuele has engaged in a more factual report of
the weekend (extract 5). These practices do not convey specific knowledge
about how Samuele might have felt. They are, at most, best guesses
grounded on general knowledge about Samuele (extract 4) or on what he has
already made available in the meeting (extract 5).
Downgraded claims of pre-existing knowledge
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15
The following extract is a continuation of extract 5. Marzio’s turn at
the end of extract 5 is reproduced at the beginning of extract 6 for
convenience.
Extract 6 (Pg3B:365)
01 Mar Ma ieri è stata la giornata But yesterday it was the hardest
02 più dura dicevi comunque. day you said anyway.
03 (1.2)
04 Sam tch Sì (.) non è stata una tch Yes (.) it was not a
05 giornata dura. hard day.
06 (1.0)
07 Noioso? Boring?
08 (1.6)
09 Mar No (.) mi sembrava: di No (.) I think I
10 capire che dal diario understood from the diary
11 era stata un po’ più it was a little more
12 pesa:nte ieri rispetto a hea:vy yesterday compared to
13 venerdì. Friday.
14 (0.4)
15 Quello che dicevi tu prima. What you said before.
16 (0.7)
17 Pensieri (.) o Thoughts (.) or
18 (1.5) altre cose (1.5) other things
19 (non so) (I don’t know)
20 (0.8)
21 Sam Sì: verso sera, (eran) Yes: in the evening, (they were)
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
16
22 considerazioni. considerations.
23 (1.7)
Samuele’s answer rejects Marzio’s interpretation of his earlier talk:
Sunday was not a “hard” day, it was “boring” (line 7). It is also resistant,
insofar as it avoids providing more than minimal access to Samuele’s inner
experience. Marzio’s subsequent turn pursues Samuele’s alignment in a
post-expansion environment (Schegloff 2007). The first component of this
turn (lines 9-13) embeds a stronger claim of knowledge, insofar as it
invokes pre-existing and independent (although, of course, mediated) access
to Samuele’s experience (Heritage and Raymond 2012). As a matter of fact,
Marzio mentions a diary (line 10), which the clients are required to write on
a daily basis. The delayed production and the design of this “my side”
telling testify to its dispreferred quality. Marzio uses a double evidential (“I
think I understood”, lines 9-10) and qualifies his description of Samuele’s
affective experience (“a little more”, line 11). Following gaps in which
Samuele’s response is not forthcoming, Marzio expands his turn, first by
again invoking what Samuele said earlier in the meeting (line 15), then by
producing a bid to continue the description of the experience, in the form of
a syntactically incomplete candidate answer (“Thoughts (.) or (1.5) other
things (I don’t know)”, lines 17-19). Samuele’s response again exhibits a
resistant quality, insofar as it is minimally designed. Despite being
composed of two turn units, it does not add information. The generic
description “considerations” displays a low level of empirical engagement
in the referred-to matters and, hence, conveys Samuele’s unwillingness to
disclose aspects of his experience.
This example suggests a dilemma that the TC educators face when
pursuing information about a client’s experience. Inquiries and “my side”
tellings that index a relatively unknowing epistemic stance seem to be
interactionally preferred, insofar as they provide for the client to produce
information on his inner state instead of producing it on his behalf. At the
same time, though, these practices might fail to provide the warrant for the
continuing pursuit of information regarding Samuele’s experience. The
claim of independently pre-existing knowledge embedded in Marzio’s turn
in lines 9-13 provides such a warrant. However, it also exposes Marzio to
possible rejection or criticism by Samuele, for at least three reasons. First,
this claim is produced in an environment already characterised by
disagreement. Second, because Samuele has already rejected Marzio’s
previous interpretation of his affective state, this new claim can be heard as
challenging the client. Third, it can be heard as intrusive with respect to the
client’s experience. An orientation to the disaffiliative character of his
epistemic claim is embodied in its elaborated turn design and its delayed
production.
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
17
Upgraded claims of pre-existing knowledge
After extract 6, the educators have further pursued talk (not shown
here) about Samuele’s experience in the course of the weekend. At the
beginning of extract 7, Samuele declines an invitation by Annamaria to tell
more on the matter.
Extract 7 (Pg3B:507)
01 Sam (No no va) bene così. (No no it’s) okay.
02 (1.4)
03 Ann £Cioè stai bene così a tenerti £That is you are ok keeping
04 tutto de:ntro Samue:le.£ everything insi:de Samue:le.£
05 (0.2)
06 £Scusa se insi:sto un £Excuse me if I insist a
07 pochi:no perché: (1.8)
little bi:t because: (1.8)
08 Sam Ho par[lato (.) °tantissimo°= I’ve ta[lked (.) °quite a lot°=
09 Ann [in realtà da:- [actually from:-
10 =dalle co:se che:: (0.3) hai de:tto =the thi:ngs that:: (0.3) you sai:d
11 tu anche descrive:ndo il tuo fine also descri:bing your weekend
12 settima:na è abbastanza chia:ro it’s quite clea:r
13 che ci so:no dei pensie:ri che ti that there a:re some thou:ghts that
14 frullano per la te:sta. are spinning through your mi:nd.
15 (2.0)
16 Sam Ma sì: la considerazione But yes: the consideration
17 che ti ho- (1.0) messo sul diario? that I- (1.0) put in the diary?
18 (0.3)
19 Dia N:o::. mi si è staccato N:o::. I lost
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18
20 il brillanti:no. the stra:ss.
19 (4.7)
20 °Me:rda:° °Shi:t:°
21 Ann £Tradu:ci?£ £Transla:te?£
22 Sam .h L’ultima considera↑zio:ne. .h The last conside↑ratio:n.
23 (0.7)
24 che tante vo:lte::: era più that many ti:mes::: it was
25 facile: (0.7) la vita di prima easier: (0.7) the life before
26 nel senso che comunque avevi in the sense that anyway you had
27 più motivazione, (1.8) more motivation, (1.8)
28 nel fare proprio le cose. in doing things really.
In lines 3-4 Annamaria provides an interpretation of Samuele’s prior
turn which challenges his claim of feeling well (Voutilainen, Peräkylä, and
Ruusuvuori 2010). This “my side” telling is not designed as a dispreferred
response (the only mark of dispreferredness possibly being the gap in line
2), however the ‘smiley’ quality of its vocal production mitigates its
challenging character. Furthermore, its dispreferredness is acknowledged in
a turn-expansion containing a meta-comment on its ‘insisting’ nature (lines
6-7). In line 8, Samuele resists the incitement to talk by complaining that he
has already talked quite a lot. In overlap, Annamaria expands her statement,
now displaying independently accessed knowledge of Samuele’s inner state.
Like Marzio’s display of knowledge in extract 6, Annamaria’s turn pursues
Samuele’s alignment. It achieves this import by making available an
account for Annamaria’s insistence, conveying that she has good reasons to
be concerned about Samuele’s personal state. Compared to the design of
Marzio’s claim of knowledge in extract 6, however, Annamaria’s statement
is designed to display a stronger epistemic stance. By invoking Samuele’s
earlier description of his own weekend (lines 9-12), Annamaria now claims
that it is “quite cle:ar” that Samuele had thoughts spinning through his mind.
Given the higher level of epistemic certainty with which this claim is made,
it raises the pressure on Samuele and makes it harder for him to further
resist the encouragement to talk.
Annamaria’s claim is interpreted by Samuele as being grounded in
what he wrote in his diary (lines 16-17). After Diana’s (another client)
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
19
comment (which is designed as unrelated to the exchange in progress
between Annamaria and Samuele), Annamaria builds on Samuele’s now
provided recognition of the validity of the educator’s claim. This is finally
followed by a more articulated description of Samuele’s experience.
Discussion
There are stakes involved in information elicitation, provision and
management in TC Monday meetings. The TC educators depend on the
clients to provide information regarding their activities and experiences in
the previous days. At the same time, there is evidence that the TC clients
can be alert to the prospective possibility of being evaluated on the basis of
the information that they provide. These potentially contrasting agendas can
lead to epistemic struggles in the meetings. I have considered one form that
such struggles can take by analysing a case where a client withholds
information. In the case examined in this study, the educators deal with a
client’s resistance by progressively increasing the pressure on him to
provide information on his inner state in the days preceding the meeting. At
the least imposing hand of the continuum, the educators display their
commitment to gain knowledge of the client’s experience by exhibiting a
relatively unknowing epistemic stance, with no claim about how the client
might have actually felt. Following the client’s continued resistance, though,
the educators start to claim pre-existing knowledge of his inner state. I have
argued that the relative ordering of practices indexing differential states of
knowledge reflect a preference for having the client provide information
about his inner state. Evidence for this preference can be found in the
delayed production of downgraded and upgraded knowledge claims and in
the accounts and mitigations that accompany their production.
The cases examined in this article suggest that information
management is a prominent part of the educators’ work in Monday meetings
(and possibly in other situations as well). The TC educators appear
committed to obtain information about the clients’ activities and mental
states as part of their institutional remit. This is testified, for instance, by
their use of devices (such as the diary mentioned in extracts 6 and 7) whose
main purpose appears to be the gathering of information regarding the
clients’ activities and experiences. As a matter of fact, the TC educators are
required not only to support the clients but also to monitor their behaviours
(Shah, and Paget 2006). At the interface between these tasks, the TC
educators can encounter practical dilemmas, one of which I have explore in
this article. The practice of withholding claims of pre-existing knowledge is
in accordance with a preference for having the clients report on their own
experiences, but they can fail to provide the warrants for the continuing
pursuit of a report of those experiences. On the other hand, claiming pre-
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
20
existing knowledge can provide such warrants but can expose the educators
to rejection and criticism.
References
Drew, Paul. 1998. “Complaints about transgressions and misconduct.”
Research on Language and Social Interaction 31: 295-325.
Drew, Paul, and Elizabeth Holt. 1988. “Complainable Matters: The Use of
Idiomatic Expressions in Making Complaints.” Social Problems 35: 398-
417.
Drew, Paul. 2012. “What Drives Sequences?” Research on Language &
Social Interaction 45: 61-68.
Heritage, John. 1984. “A change-of-state token and aspects of its sequential
placement.” In Structures of Social Action: Studies in Conversation
Analysis, ed. by J. Maxwell Atkinson, and John Heritage, 299-345.
Cambridge: Cambridge University Press.
Heritage, John. 2011. “Territories of knowledge, territories of experience:
empathic moments in interaction.” In The Morality of Knowledge in
Conversation ed. by Tanya Stivers, Lorenza Mondada, and Jakib
Steensig, 159-183. Cambridge: Cambridge University Press.
Heritage, John. 2012. “The Epistemic Engine: Sequence Organization and
Territories of Knowledge.” Research on Language & Social Interaction
45: 30-52.
Heritage, John, and Geoffrey Raymond. 2012. “Navigating Epistemic
Landscapes: Acquiescence, Agency and Resistance in Responses to Polar
Questions.” In Questions: Formal, functional and interactional
perspectives, ed. by Jan P. de Ruiter, 179-192. Cambridge: Cambridge
University Press.
Koshik, Irene. 2010. “Questions That Convey Information in Teacher-
Student Conferences.” In "Why Do You Ask?" The Function of Questions
in Institutional Discourse, ed. by Alice F. Freed, and Susan Erlich, 159-
186. Oxford: Oxford University Press.
Macpherson, R., T. R. Edwards, R. Chilvers, C. David, and H. J. Elliott.
2009. “Twenty-four hour care for schizophrenia (Review).” Cochrane
Database of Systematic Reviews, Issue 2.
Mandelbaum, Jenny. 1991/1992. “Conversational Non Cooperation: An
Exploration of Disattended Complaints.” Research on Language &
Social Interaction 25: 97-138.
Peräkylä, Anssi, and David Silverman. 1991. “Owning Experience:
Describing the Experience of Other Persons.” Text 11: 441-480.
Pomerantz, Anita. 1980. “Telling My Side: "Limited Access" as a "Fishing"
Device.” Sociological Inquiry: 3-4, 186-198.
Pino - Epistemic Struggles in Addiction Therapeutic Community Meetings
21
Robinson, Jeffrey D., Galina B. Bolden. 2010. “Preference organization of
sequence-initiating actions: The case of explicit account solicitations.”
Discourse Studies 12: 501-533.
Sacks, Harvey. 1987. “On the preference for agreement and contiguity in
sequences in conversation.” In Talk and social organization, ed. by
Graham Button, and John R. E. Lee, 54-69. Clevedon: Multilingual
Matters.
Schegloff, Emanuel A. 2000. “Overlapping Talk and the Organization of
Turn-Making for Conversation.” Language in Society, 29: 1-63.
Schegloff, Emanuel A. 2007. Sequence Organization in Interaction: A
Primer in Conversation Analysis I. Cambridge: Cambridge University
Press.
Shah, Deepa, and Sarah Paget. 2006. Service Standards for Addiction
Therapeutic Communities (1st edition). London: The Royal College
Psychiatrists'.
Sidnell, Jack. 2010. Conversation Analysis: An Introduction. Malden, MA:
Wiley-Blackwell.
Voutilainen, Liisa, Anssi Peräkylä, & Johanna Ruusuvuori, 2010.
“Recognition and Interpretation: Responding to Emotional Experience in
Psychotherapy.” Research on Language and Social Interaction, 43: 85-
107.